Individualized fertility preservation counselling for women with endometriosis-a systematic review

Endometriosis is a chronic disease that may require surgical intervention under certain circumstances. Although the condition itself is associated with impaired fertility in 30-50% of affected individuals, surgical treatment may further reduce ovarian reserve and thereby additionally compromise fertility. As fertility preservation (FP) is increasingly being considered in this context, a clear understanding of how ovarian surgery affects the remaining follicle reserve and the outcome of oocyte cryopreservation is essential to guide counselling on the appropriate timing. The purpose of this study is to summarize the available evidence on the impact of ovarian surgery on oocyte retrieval outcomes in the context of FP and to propose a counselling framework based on these findings. The search of electronic databases identified seven observational studies on this topic. In terms of oocyte cryopreservation outcomes, the included studies consistently reported a decrease in the total number of oocytes retrieved in cases of previous surgery for endometriosis. Reported mean or median oocyte numbers ranged approximately from 8 to 14 per cycle in non-operated patients, with significantly lower yields in previously operated women ranging from about 4.5 to 7 oocytes per cycle. Existing evidence suggests that previous ovarian surgery for endometriosis negatively affects oocyte yield for FP, but long-term reproductive outcomes remain insufficiently characterized. Such data would be required to enable a more accurate assessment of FP effectiveness. The available evidence indicates that FP counselling should be individualized, with particular emphasis on women with diminished ovarian reserve, age >35 years, or planned bilateral or repeated ovarian surgery.